Abstract
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Background
Modelling is a flexible and efficient approach to gaining insight into the trade-offs surrounding a complex process like breast screening, which involves more variables than can be controlled in an experimental study.
Data and methods
The University of Wisconsin Cancer Intervention and Surveillance Modeling Network (CISNET) breast cancer microsimulation model was adapted to simulate breast cancer incidence and screening performance in Canada. The model considered effects of breast density on the sensitivity and specificity of screening. The model’s ability to predict age-specific incidence of breast cancer was assessed.
Results
Predictions of age-adjusted incidence over calendar years and age-specific incidence of breast cancer in Canadian women are presented. Based on standard screening strategies, ratios of in situ to invasive disease and stage distribution of disease at diagnosis are compared with data from the British Columbia provincial screening program.
Interpretation
The adapted model performs well in predicting age-specific incidence and cross-sectional incidence in the absence of screening. The ratios of detection of in situ to invasive cancers and the overall stage distribution of detected cancers are in reasonable agreement with empirical data from British Columbia.
Keywords
Breast screening, incidence, microsimulation model, preventive health, sensitivity, specificity
Findings
Organized provincial breast cancer screening programs have operated in Canada since 1988. These programs contribute to mortality reduction, but they use substantial resources. [Full Text]
Authors
Martin J. Yaffe (martin.yaffe@sri.utoronto.ca) is with the Physical Sciences Program at the Sunnybrook Research Institute and the Departments of Medical Biophysics and Medical Imaging, University of Toronto. Nicole Mittmann is with Cancer Care Ontario. Pablo Lee is with the Institute for Technology Assessment at the Massachusetts General Hospital. Anna N.A. Tosteson is with the Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth. Amy Trentham-Dietz is with the Department of Population Health Sciences and Carbone Cancer Center, University of Wisconsin. Oguzhan AIagoz is with the Department of Population Health Sciences and Carbone Cancer Center and the Department of Industrial and Systems Engineering, University of Wisconsin. Natasha K. Stout is with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute.
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What is already known on this subject?
- Organized provincial breast cancer screening programs have operated in Canada since 1988.
- Decisions about whether to screen, who should be screened, how frequently to screen, and what modalities to use are best made when trade-offs between improved health outcomes, potential harms, and monetary costs are understood.
- Modelling is a flexible and efficient approach to gaining insight into these trade-offs, which involve too many variables to control in an experimental study.
What does this study add?
- This study describes the modification and testing of a validated microsimulation model of breast cancer, which was developed based on the U.S. population; the modifications reflect the current Canadian context .
- The adapted model performs well in predicting age-specific incidence and cross-sectional incidence in the absence of screening.
- The ratios of detection of in situ to invasive cancers and the overall stage distribution of detected cancers are in reasonable agreement with empirical observations.
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